The death of a young Nigerian doctor after 72 hours on duty has sparked national concern and reflection. While painful, this incident must be seen as more than an isolated tragedy but a signal of systemic pressures that have long challenged Nigeria’s health sector. It also presents a chance to accelerate sustainable reforms that will not only protect the lives of healthcare workers but also strengthen the overall quality of patients’ care and restore confidence in Nigeria health system.
Context and significance
Nigeria’s health sector has been stretched for decades, with workforce shortages, high patient loads, and inadequate infrastructure. The World Health Organization recommends one doctor for every 600 patients, yet Nigeria’s current ratio is closer to one for every 5,000.
Despite this, government and stakeholders have made commendable efforts. The Basic Health Care Provision Fund has helped to expand access, and the recent push to train more health professionals demonstrates forward thinking. Yet, the tragic loss of this doctor shows that more must be done, particularly in workforce welfare and sustainable staffing systems.
Existing Policy Foundations on Workplace Safety in Nigeria
Nigeria has not been silent on the issue of occupational health and safety. Over the past decade, several frameworks have been established to safeguard workers, including those in the health sector. The 2014 National Occupational Safety and Health (OSH) Policy laid early groundwork for inspection and compliance systems across workplaces. More recently, the Federal Government launched the National Occupational Safety and Health Strategic Plan (2024–2028). This was designed to improve workers’ well-being, reduce occupational hazards, and align national efforts with international labour standards.
Additionally, the creation of an Occupational Safety and Health Department under the Ministry of Labour, alongside the annual National OSH Summit, provides institutional platforms for dialogue, innovation, and accountability. Nigeria has also ratified key International Labour Organization conventions, including Convention No. 187 on the Promotional Framework for OSH and Convention No. 190 on Violence and Harassment. This further demonstrates a commitment to global best practices.
These initiatives offer a solid foundation for reform. However, what is urgently required now is to translate frameworks into consistent practice within the health sector. Also, it is essential to ensure that existing policies move beyond paper into real protections for doctors, nurses, and other frontline workers. The current tragedy should serve as a catalyst for applying these policies rigorously and adapting them to the unique pressures of healthcare delivery in Nigeria.
Why incidents like this matter needs urgent attention
1) Humanitarian concern: there is a dire need to protect those who protect us
Beyond headlines, a doctor’s collapse or death after an extended shift is first and foremost a human tragedy. Framing it as a humanitarian issue centers on dignity, safety, and the moral obligation that the state and society owe to our healthcare workers.
Implications for Policy and Practice
Physical & mental harm: Prolonged fatigue increases risk of cardiovascular events, infections, depression and burnout among health workers.
Family and community impact: The loss or long-term disability of a health worker affects dependents and local service capacity, especially in rural areas where alternatives are scarce.
Equity dimension: Overwork often disproportionately affects younger, less-senior staff such as interns, residents, junior nurses and women, who may also shoulder domestic responsibilities.
Policy and programmatic responses
Immediate: Introduce mandatory rest periods, access to on-site emergency care for staff, and psychosocial support after traumatic events.
Medium-term: Institutionalize occupational health units in hospitals; offer family support packages such as bereavement, and financial assistance when incidents occur.
Long-term: Embed worker safety metrics in national and state health performance frameworks such as staff morbidity/mortality rates as well as the incidence of work-related illness.
Suggested key performance index (KPI) that can be used in tracking these responses are 1. number of work-related health incidents per 1,000 staff, 2. percentage of hospitals with occupational health units and 3. staff utilization of mental-health services.
2) Public trust: fatigue equals risk to patients
Patient safety and confidence in the health system rest heavily on the competence and alertness of the clinicians. When clinicians work for a number of extreme hours, the risk of preventable medical errors rises and with it, public alarm and loss of trust can set in.
Implications for Policy and Practice
Clinical errors: Fatigue impairs judgment, procedural skill, and response time. These can increase adverse events such as wrong-site surgery, medication errors, delayed diagnoses.
Perception and behaviour: High-profile incidents erode trust, it reduces citizens’ uptake of services such as maternal care, immunization, and drive patients to informal or private alternatives that may be costlier or unsafe.
Liability and cost: Medical errors can create downstream costs in terms of longer admissions and litigation that are higher than the investments that are required to prevent staff burnout.
Policy and programmatic responses
Immediate: Enforce maximum shift policies for high-risk functions such as surgery, emergency, and anesthesia; deploy cross-cover staffing to avoid 24 hour duty.
Medium-term: Invest in task-shifting and team-based care models so that care continuity does not depend on one individual.
Long-term: Strengthen patient-safety reporting systems that link incidents to staffing and fatigue indicators, and publish regular transparency reports.
Suggested key performance index (KPI) that can be used in tracking these are 1. rate of adverse events per 1000 admissions; 2. patients’ satisfaction/trust index; 3. percentage of clinical units compliant with duty-hour guidelines.
3) Policy urgency: convert tragedy into a strategic reform window
A public tragedy of this type can create political and public attention which is an opportunity that policymaker rarely get. However, the goal is to transform shock into sustained, and institutional change rather than temporary sympathy.
Implications for Policy and Practice
Political will: Tragic events can mobilize funding, committees, and legislative momentum that routine reports seldom achieve.
System-level leverage: Workforce policy, budgeting, and regulatory reform are achievable when anchored to a clear public-health imperative and a feasible roadmap.
Sustainability: Rapid, well-governed responses can reduce risk of repeats and stabilize workforce morale. This can limit the ongoing brain drain in the sector.
Policy and programmatic responses
Immediate: Convene a multi-stakeholder emergency taskforce within 30 days to issue interim duty-hour guidance. This should include ministry of health, professional bodies, unions, donors and other relevant stakeholders in the Nigeria health ecosystem
90-day deliverable: Draft, adopt and implement a national workforce safety policy (duty hours, occupational health, emergency support).
12-month deliverable: Integrate workforce safety into the national health financing strategy and begin scaling pilots through innovative approaches such as digital rostering, recruitment incentives.
Monitoring & accountability
Publish a quarterly dashboard linking incidents, staffing levels, funding allocations, and progress against the 12-month plan. Assign clear ministerial leads and committee oversight to ensure continuity beyond the immediate crisis.
It is essential to treat this tragedy as a policy inflection point. If properly implemented, it will protect the workforce for humanitarian reasons, restore and safeguard public trust for patient safety, and seize the political moment to lock in reforms that will prevent repetition. Acting collaboratively and transparently now will yield measurable gains in staff welfare, patient outcomes, and system resilience.
Root Causes of Overwork in Nigeria Health sector
Several interlinked factors continue to drive excessive workload in Nigeria’s hospitals. While daunting, none are insurmountable but they require coordinated, multi-sectoral actions and sustained policy follow-through.
1. Workforce Shortages and Brain Drain
Nigeria’s doctor-to-patient ratio is estimated at 1:5,000 compared to the WHO’s recommended 1:600. The shortage is compounded by medical brain drain. The Nigerian Medical Association (NMA) reports that over 10,000 Nigerian-trained doctors practice in the UK alone, while thousands more are in the US, Canada, and Saudi Arabia. Nurses are also emigrating in large numbers due to global demand. This has resulted to a situation where those who remains face overwhelming caseloads far beyond international safety norms.
Without urgent win-win retention strategies and commensurate incentives to give professionals expected welfare package, the gap will continue to widen which will put unbearable strain on hospitals.
2. Economic Pressures and Dual Practice
Many Nigerian health workers are underpaid relative to workload. According to the World Bank and independent labour studies, average doctor salaries in Nigeria are a fraction of what counterparts earn in other countries while delayed payment of allowances worsened the problem. To cope, many doctors and nurses practice in both public and private facilities, and sometimes across states. This is resulting in long shifts and minimal rest. The implication is that economic insecurity directly translates to physical exhaustion and declining quality of care. Without wage reforms and better welfare packages, burnout and attrition will escalate.
3. Ineffective Shift Management and Oversight
Unlike countries that enforce strict duty-hour caps such as 80 hours/week for US medical residents, Nigeria national policies on maximum working hours for health workers need adequate attention on compliance. Where guidelines exist, enforcement is weak. Resident doctors and interns often endure 24–36 hour shifts without adequate relief. The absence of regulatory enforcement means that fatigue is normalized, and hospitals’ insufficient accountability structures to protect their own staff.
4. High Emergency Burden
Nigeria faces a unique blend of emergencies which range from road traffic accidents (over 41,693 deaths annually (FRSC, 2021), high maternal mortality (512 per 100,000 live births according to WHO, 2020), infectious diseases like malaria (27% of global malaria cases as reported by WHO Malaria Report, 2022), and a rising tide of non-communicable diseases. Many cases that should be managed at the primary healthcare level end up overwhelming tertiary hospitals because of weak referral systems (World Bank, Nigeria Health System Assessment, 2020).
Due to these scenario, the over-reliance on tertiary centers without strengthening primary and secondary care creates unsustainable pressure on urban teaching hospitals and their staff.
Global and Regional Lessons
Other countries have faced similar challenges. In the early 2000s, the United States and the United Kingdom capped resident doctors’ working hours after studies linked fatigue to medical errors. South Africa and Kenya have also grappled with overwork-related tragedies among doctors, leading to policy discussions on duty limits.
These examples show that reform is both possible and beneficial. It leads to improvement in both health workers’ well-being and patient outcomes. Nigeria can draw from these lessons while tailoring solutions to its context.
Why We Must Act Now
The urgency is clear:
More health workers may leave if conditions remain harsh.
Patients risk unsafe care when doctors are overstretched.
Nigeria’s commitments to the Sustainable Development Goals (SDGs), particularly Goal 3 on health, depend on a resilient and protected workforce.
This moment offers a chance to prevent further tragedies by making pragmatic and people-centered reforms.
Our Shared Responsibilities?
Health Professionals
Health professionals should encourage open dialogue on safe working conditions and adopt self-care practices. Regular contributions to advocacy for sustainable reforms must also be champion by them.
Citizens
Nigerians should recognize healthcare workers as frontline protectors of national well-being. They should support constructive campaigns for improved healthcare investment and demand accountability.
Private Sector
Private sector should explore public-private partnerships (PPPs) to support digital hospital management systems, modern equipment, and wellness initiatives. The current situation in the sector is an avenue for medical business opportunities for bold investors.
Government
Government should lead the reform process by:
Recruiting more doctors and nurses to reduce workloads.
Updating policies to limit maximum shifts to the safe levels.
Expanding incentives that encourage retention of professionals in Nigeria.
Development Partners
Development partners in the health ecosystem should provide technical expertise, capacity building, and resources for monitoring frameworks. This will promote accountability and sustained improvements. In addition to the efforts on infrastructure, there is a dare need to significantly invest in manpower and quality of life for the workforce that make the system functional.
What Policy Opportunities Exist?
Shift Management Reform: Establish clear national guidelines that limits maximum consecutive hours for healthcare staff.
Workforce Expansion: Prioritize recruitment, with special incentives for underserved areas.
Remuneration and Welfare: Ensure competitive pay and wellness packages.
Infrastructure Upgrade: Invest in digital rostering, telemedicine, and modern hospital systems.
Legal Safeguards: Strengthen occupational health laws to cover medical staff welfare.
A 12-Month Action Calendar
Month 1–2: National Dialogue
Begin by bringing everyone to the table. The Federal Ministry of Health, alongside the Nigerian Medical Association (NMA) and other relevant institutions should convene a national dialogue on health workforce safety. This step will help to build consensus among all stakeholders on shared priorities.
Month 3: Policy Guidelines
Next, the Ministry of Health, in collaboration with the National Assembly, should issue policy guidelines on maximum duty hours. This provides a much-needed policy framework to safeguard healthcare workers’ well-being.
Month 4–5: Staffing Support
During this stage, both state and federal governments are advised to recruit and deploy additional qualified staff across the states. The immediate outcome will be a reduction in excessive workload for existing health workers.
Month 6: Welfare Committees
Hospital Management Boards should establish hospital welfare committees nationwide. These committees will serve as dedicated channels for worker supports, welfare monitoring and regulations. Adequate sanctions and consequences to defaulters should be established and well advertise to Hospitals and health centres across the country
Month 7–8: Digital Rostering
With private sector support, hospitals can pilot digital duty rostering systems. This move will enable efficient workforce planning and more balanced schedules for staff.
Month 9: Self-Care & Occupational Health Training
Development partners should introduce training programs on self-care and occupational health. This is essential for nurturing a resilient and healthier workforce.
Month 10: Mid-Year Review
The Ministry of Health and its partners should pause to conduct a mid-year progress review. This will allow timely policy adjustments and ensure that the plan remains on track.
Month 11: Public Campaign
Media and civil society organizations can then launch a public campaign on valuing healthcare workers. Strong public engagement at this stage can help to shift perceptions and increase community support.
Month 12: National Review & Planning Conference
Finally, all stakeholders should gather for a national review and planning conference. This is where a sustainability roadmap will be crafted to secure long-term improvement for the health workforce.
Conclusion
The death of a young doctor after 72 hours of duty is a tragedy that cannot be forgotten. But it can be the starting point for systemic change. Nigeria has the expertise, partnerships, and policy frameworks to build a stronger and safer health workforce.
This moment calls for shared responsibility from government, private sector, development partners, civil society, and health professionals themselves. By turning this tragedy into a reform milestone, Nigeria can safeguard her healthcare workers, protect her patients, and strengthen the nation’s health system for generations to come.
The path forward is clear. The time to act is now.
Dr. Aremu Fakunle is an Agribusiness and Public Policy expert based in Abuja, Nigeria
